Provider Demographics
NPI:1306020391
Name:GOLDSTEIN, TRISTA (RN, NP)
Entity type:Individual
Prefix:
First Name:TRISTA
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CHELSEA DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-2910
Mailing Address - Country:US
Mailing Address - Phone:516-554-4575
Mailing Address - Fax:
Practice Address - Street 1:350 30TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3424
Practice Address - Country:US
Practice Address - Phone:510-444-0790
Practice Address - Fax:510-835-7841
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14819363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner